ACA MEMBER BLOGS

DSM-5 Disorganization, Disarray, and Delays

DSM 5 keeps missing its own deadlines and the DSM 5 publication date is fast approaching. I am afraid there is insufficient time left for thoughtful preparation or adequate public input. Here's a brief history of DSM 5's consistent failure to deliver on time:

On the DSM-5 Field Trials in Academic/Large Clinic Settings: These were originally scheduled to begin in 2009, prior even to the draft proposals being reviewed and vetted by outside mental health professionals. But, after much criticism, the DSM-5 Task Force wisely postponed the start date to June 2010. Unfortunately, the Task Force then came up with an impossibly complicated field trial design that was roundly criticized for missing the relevant questions and having a completely unrealistic timetable. Not surprisingly, the start and end dates have been repeatedly delayed. The study was originally planned for completion in early 2010, then in early 2011, and now we are entering 2012 with still no end in sight. This expensive field trial will be essentially worthless because of its lateness, its poor design (which doesn't test the impact of DSM 5 on diagnostic inflation), and its failure to test final DSM 5 wordings because these were not always ready on time.

On the Routine Clinical Practice Field Trial: I have serious concerns whether this will ever get done. I just received a flyer by APA’s Practice Research Network called “Inside the DSM-5 Field Trials” (December, 2011), which stated that since July 2011, “clinicians from around the globe” have volunteered to participate in the trial. But APA surreptitiously avoided mentioning that the volunteer selection and training process was originally to have been completed by August 2010 and has been delayed first to 2011 and now to 2012. The whole effort has been wrought with confusion, disorganization, ineptitude, and constant delays. I applied to be a volunteer clinician in November 2010 and was accepted April 29, 2011. Between April and late August, I experienced numerous problems: no contact about training; no responses to repeated emails or phone calls; inability to access field trial information online; APA losing my consent form; and being informed three times that training materials would be emailed 'in a few weeks'- which never happened. Finally, after these many miscues, the field trials 'officially' began in September 2011. In November, APA announced it was extending the field trials to March 2012 in order to recruit more participants. There’s a desperate failure motivating this extension– according to the APA flyer, out of “over 5000 clinicians” eligible to participate, only 195 have completed the training, and a mere 70 (1.4%) are enrolling patients. This field is clearly a total bust.

On The Open Periods For Public Comment: APA has repeatedly bragged about the “unprecedented” open comment periods whereby clinicians can post comments about the DSM-5 proposals online during specified time periods. Ironically, the first comment period in January/February 2010 was initiated only after outside pressure insisted that all proposed revisions be reviewed and vetted by the field before field trials could begin. And, interestingly, very few substantive changes have been made in response to public comments since the first drafts were posted- despite the fact that so many DSM-5 proposals have been so heavily criticized. The final public comment period was originally scheduled for September/October 2011, but has been twice postponed because everything is so far behind– first to January/February 2012 and recently to May 2012. Given this late date, new public feedback will almost certainly have no impact whatever on DSM-5 and appears to be no more than a public relations gimmick.

K. Dayle Jones is a counselor and associate professor at the University of Central Florida. Contact her at daylejones@ucf.edu